Health coverage: Navigating new waters

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WALLA WALLA — Confused about signing up for health insurance coverage under the Affordable Care Act?

Join the rest of the country, said Maria Benavides, outreach program director for Yakima Valley Farm Workers Clinic.

“Everybody already has questions,” she said.

And people need answers to those questions by Oct. 1, when the enrollment period running through March 31 starts. Coverage begins Jan. 1

Benavides’ organization heads Family Medical Center, one entity in Walla Walla County authorized to employ “navigators” to guide people through the enrollment process.

Person-to-person assistance through such navigators is one method to find the right coverage among the 34 options inside five health plans that will be available locally.

Some people will get information and enroll themselves through the Washington’s Health Benefit Exchange, a public-private partnership that is largely federally funded. The exchange’s online Washington Healthplanfinder opened this month as an insurance marketplace for individuals, families and small businesses to compare health insurance coverage.

Users can find information about tax credits, reduced cost sharing and public programs such as Medicaid, which will insure the poor and near-poor.

Others will buy private plans through registered insurance brokers. A thousand or so trained insurance sales professionals are registered through the Washington state Office of the Insurance Commissioner to help residents find health plan products.

Experts estimate another 1,000 agents will eventually join those qualified to sell plans.

State officials anticipate enrolling 1 million Washington residents who are uninsured. In Walla Walla County, 8,541 — just over 18 percent of the population — are uninsured.

More than 4,000 will qualify for Medicaid under the new health-care law. About 3,700 others who are now uninsured will be eligible for premium discounts on privately-purchased insurance plans, unless they are ineligible by other circumstances, like undocumented immigrants, officials said.

Using navigators

Local organizations are getting ready to come on board to help people one-on-one, said Wes Luckey, director of the state’s Health Benefit Exchange Navigator In-Person Assistor Program for Benton, Franklin and Walla Walla counties.

By Oct. 1, Luckey expects people working in public health, advocacy, social services, long-term care agencies and hospitals to join the list of those who can guide people in Walla Walla County needing health insurance.

Those guides are undergoing 20 hours of training and Washington State Patrol background checks. Those who are signing on as bilingual must pass a language competency test, Luckey said.

Paid navigators are sometimes referred to as patient benefit coordinators, and they will be ready to answer questions the minute people can begin signing up on Oct. 1, Benavides said. Family Medical Center has employed three “inreach” coordinators who will steer clinic patients toward continuing to use the medical clinic.

“Anyone who comes into our clinic as a patient will be asked if they have insurance. They’ll get assistance in finding a plan,” she said.

Anyone using one of the regional health exchange navigators will get free, unbiased help, even as his office is focusing on the expansion of Medicaid rolls, Luckey said.

Online on your own

Online will be the route many people will follow, Benavides said.

“They will go through this on their own.”

Washington residents can enroll in health insurance on the website wahealthplanfinder.org without outside assistance if they choose.

The site demands no identifying information while browsers are shopping or looking at eligibility for financial help. Plans can be compared side-by-side.

The website is designed to give individuals, families and small business owners information to choose the plan that best fits needs and budgets. The agency’s staff is accessible online or by phone at 855-923-4633.

Work with an agent

State licensed and certified insurance agents, also called brokers and producers, can sell health-care plans that will available in Walla Walla County. People can contact their current insurance broker or get information about working with an agent at 855-923-4633, starting Oct. 1.

That’s the day the exchange will release names of qualified insurance agents for each area, noted Bethany Frey, senior communications specialist for Washington Health Benefit Exchange.

With 34 options to look at, agent will be useful to shoppers unsure of what best fits their needs and resources.

Agents will receive sales commissions but that cost is not expected to be passed on to the consumer, insurance experts say. The company that gets the business — say, Group Health Cooperative or Premera Blue Cross — pays agent commissions.

Most agents will already be well versed in health insurance products and eager for business, experts say. As well, brokers will complement the work of the navigators, who should not be making specific recommendations.

Consumers need to check if an agent is certified to sell, Luckey said.

“They need to ask if (the agent is) appointed with all the available plans,” he said. “Brokers have to have filled out the paperwork, they have to have a life and disability insurance product, which covers health. If not, they cannot sell to you.”

Washington is one of the most heavily regulated states in the nation, with a strong insurance commission presence, he said. That is likely to help keep a lid on high rate increases in the future.

“The Office of the Insurance Commissioner takes out the microscope and looks at those,” Luckey said. “That will often cause a company to back that rate down.”

Questions about agents or complaints can be directed to the insurance commissioner at 800-562-6900 or 360-725-7080, or go to insurance.wa.gov.

Check with your doctor

Whatever method people use to obtain insurance, they should first check with their health providers to see what insurance plans they will accept after Oct. 1.

“Make sure you get the plan that matches, you want to have the continuum of care,” Benavides said. “Not a plan where you may have to go out of your area, that gets a little messy.”

Everyone involved in health care is running hard to get things in place for consumers, she added.

“We have a lot of the answers and some things we just don’t know how it will work out ... because no one has done this,” she said. “We’re going to be learning as a state. As a nation.”

Luckey said he expects people to quickly come to see the Affordable Care Act is a good thing.

“I’ve been in health care for 30 years and in all that time, this is the most significant change I’ve seen,” he said. Enrolling in Medicaid, for example, has always taken 45 days to determine eligibility, he noted.

“That process has been condensed into 45 minutes.” Luckey said. “There might be a wait for confirmation of information, but you will be enrolled immediately. This is a huge thing that will effect the health of the population.”

Sheila Hagar can be reached at sheilahagar@wwub.com or 526-8322.

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